Provider Demographics
NPI:1336565985
Name:TAMULIS, VYTAUTAS
Entity Type:Individual
Prefix:
First Name:VYTAUTAS
Middle Name:
Last Name:TAMULIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587514
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-7514
Mailing Address - Country:US
Mailing Address - Phone:815-483-9504
Mailing Address - Fax:
Practice Address - Street 1:3457 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3335
Practice Address - Country:US
Practice Address - Phone:815-483-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician